Coping with a chronic disease is a formidable challenge. Owing to the disabling consequences of their underlying conditions, individuals who suffer with a chronic rheumatic disease have especially daunting lives with their existence often dominated by their health related needs. Due to the high prevalence, the demographic distribution, indeed the very nature of the rheumatic diseases, too many sufferers of these conditions in our society remain disenfranchized with respect to their access to health care. Those who come from already disadvantaged socioeconomic circumstances face particularly difficult challenges. Rheumatologists and their allied health professionals therefore, have a moral obligation to insure greater fairness to their patients - those already compromised by the natural lottery that gave them their disease.

To enhance the appreciation of this problem and to motivate the rheumatic disease community, we attempt to identify those variables that create the need for and imperil access to medical care for the rheumatic diseases. The implications of these observations are then explored from the ethical perspective of justice. We conclude with suggestions as to how to change the health care system to address these problems.

*The opinions expressed are solely those of the authors and do not necessarily reflect the views of the organizations with which they are affiliated.

This work is funded by a grant from The Fan Fox and Leslie R. Samuels Foundation to the Division of Medical Ethics of the Weill Medical College of Cornell University.

About the HSS JournalHSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.